If men don’t mentor women in medicine, where does that leave us?

A few months into medical school, my student adviser asked me how I was handling the gender gap in medicine. At the time, I hadn’t yet experienced what he meant: Over half of my new colleagues were women, and my experience of medicine was still limited to the lecture hall, where our clinician teachers were largely evenly distributed by gender.

Since then, I’ve come to see that a gender gap permeates almost all aspects of my experience as a female medical trainee. It’s reflected in the way that a patient refers to me—a resident doctor—as a “girl,” and to my male medical student colleague as “doctor.” It’s there when a colleague and I are discussing career paths, and my colleague tells me I’m more suitable for obstetrics than emergency medicine because of my “softer” nature. And I feel it when a male patient, without speaking directly to me, tells my supervising physician while I’m in the room that he should “get together” with me, because I’m “cute.”

These incidences have occurred while I’m still early in training, yet evidence suggests that gender-based disparities will also influence my career in the future. Gaps in access to leadership positions, pay, and even respect in the workplace are borne out in the literature: Women comprise only 16 percent of medical school deans and 15 percent of medical school department chairs; we are remunerated less than our male counterparts even while working in the same field; and we are more likely to have our credentials questioned and to experience sexual harassment by our patients, colleagues and supervisors.

Taken together, these numbers highlight the significant structural disadvantage women face in the workplace, with a particular spotlight of late on sexual impropriety. The #MeToo movement has served as a platform through which women have felt empowered to come forward with their experiences of sexual harassment and abuse, often by male colleagues or superiors. In medicine, this has meant an increasing recognition of the prevalence of misconduct toward women at all stages of training.

Yet #MeToo has also engendered a backlash in which men are increasingly reticent to mentor women, which, as a group of female clinician leaders recently detailed in NEJM, can have significant detrimental impacts on female physicians’ career advancement.

Medicine is a unique model of teaching and learning. As trainees, we rotate through different medical specialties, often working one-on-one with a physician preceptor whose practice style and insight significantly inform our vision of what a career in the field could look like. Consequently, our relationship with a single physician can directly influence our career choices. Common stories exchanged among my peers and colleagues are ones about specific preceptors whose teaching, research or practice have served as scaffolds on which we hope to model our careers.

And, since men occupy the majority of leadership positions in medicine, their willingness to mentor women as readily as men is pivotal in shaping female physicians’ careers, and ultimately in bridging medicine’s gender disparity.

The fear expressed about false allegations is not supported by the statistics. In fact, there is significant evidence that false accusations are the rare exception: The research shows that between two and eight percent of allegations are false reports, and this number is felt to be inflated given the spectrum of reasons why reports are ultimately dismissed.

Most recently, the number of assaults reported in Canada increased by 13 percent in 2017, perhaps demonstrating that more women who have experienced sexual assault are coming forward in the wake of #MeToo, while the rate of “unfounded” cases decreased by half, in part because allegations are now less likely to be dismissed by the authorities.

However, responding to the emerging empowerment of women by declining to mentor them threatens these gains, and suggests that women’s perceptions of men’s behaviours and intentions are hazardously unreliable.

Psychologists suggest that this reaction may be rooted in a biological aversion to a perceived threat: Despite its improbability, the fear of a false allegation is so compelling that we react disproportionately. It has also been suggested that there is a deep-seated concern over the “feminization” of medicine; the number of women enrolling in medical school has recently started to outpace that of men, and there have been suggestions—which have been disproven—that women won’t work as hard in medicine or take up as many leadership or administrative responsibilities as men.

We must recognize that the unfounded fear of false allegations perpetuates structural sexism, and proactively seek strategies for its redress. Male mentors may be more comfortable inviting male trainees to social outings, but favouring men for social meetings can also lead to favouring them for leadership or training opportunities, even if unintentionally. Instead, the mentor could invite multiple mentees to social outings, offer different environments in which to meet one-on-one, or provide opportunities for female mentees to indicate their preference for individual or group meetings as well as the settings where they will occur.

As well, formal mentorship programs exist within many institutions and facilitate universal access to mentorship with explicit expectations of what the relationship will involve. In my medical school, this took the form of randomly assigning one or two incoming medical students to senior physician mentors, with no consideration given to culture or gender. I met with my mentor every few months to review my progress and goals in the program and although we ultimately didn’t share the same clinical interest, my assigned mentor had extraordinarily valuable lessons to impart with respect to the trials of medical school, how he settled on his chosen specialty and, indeed, it was he who opened that first discussion with me on the gender gap in medicine.

And so, perhaps most importantly, mentors could also seek to have explicit conversations with their colleagues, departments, or mentees about the #MeToo movement and the importance of creating a shared understanding of mutual boundaries and expectations to ensure each party feels comfortable and secure throughout the mentorship.

As a resident physician, I stand at the beginning of my medical career. Even so, I attribute many important decisions made and milestones achieved to the support of numerous male mentors, each of whom has demonstrated the type of leadership and support I hope to emulate in future with my own mentees.

There are professional, respectful and nurturing ways in which to foster mentoring relationships in medicine. We need to use these strategies to develop a medical culture in which women are not disadvantaged by their gender.

Enter the debate: reply to an existing comment

7 comments

PhilFebruary 6th, 2019 at 7:01 pm

I wish Healthy Debate would stop with the MD-centric articles. Physicians (irrespective of gender) enjoy a certain level of privilege in society. While I don’t doubt gender equity rears its head for physicians, these sort of articles come across as doctors with privilege whining.

A more interesting article- Debate the history of power dynamics between physicians and nursing (a more feminized profession), and how that has influenced MD turf protection with scope protection against NPs.

Phil —
Respectfully, your comment perfectly encapsulates the major threat to advancing the broader gender and racial equity agenda that (I assume) we both support. Specifically, the never ending battle of whom among us is truly the most marginalized or victimized helps nobody. Of course we should examine the power differential between nurses and physicians (I am an RN), but that doesn’t mean we should ignore the issues our physician colleagues who are women face. If you work in healthcare, I have no doubt you have seen every instance the author describes. Why should we not want to support our colleagues and take down power barriers for all? And why is acknowledging their barriers mutually exclusive to tackling the MD / RN / NP power structures?

So let’s stop trying to outflank one another to highlight who can claim the most non-privileged bonafides, end the tribalism, and fight for equity for all.

Thank you for this thoughtful piece! I agree that we must foster a professional, respectful and nurturing culture to inspire more women in leadership. I agree that there should be more coaching opportunities from experienced leaders and mentors. But ultimately, we are all leaders within our own scope – to voice, to advocate, to inspire. We should all follow our own moral compass to determine the kind of leader we want to become.

The true rate of unfounded complaints is critical here as it will determine the rationality of mentor anxiety and avoidance. The rate of 2-4 % cited here is for an utterly different context, namely unfounded rape accusations to police. I don’t know whether accurate information exists on the rate of unfounded accusations of sexual impropriety on the part of mentors, but it is essential to know.

I am mid career and had fantastic male mentors although have and still face a significant amount of sexism. Despite my PhD supervisors being adorable men they took my male trainee colleagues sailing whilst I was never invited. Lots of gendered reasons for this – perhaps their wives would have frowned, perhaps they were uncomfortable socially with girls, or maybe they didn’t think I could pull my weight, maybe they were concerned for my husbands feelings…… no biggie but I did notice. It is going to take a generation or two to change that.

This document is provided under the terms of a CreativeCommons Attribution Non-commercial Share Alike license. The terms of the license are available at: http://creativecommons.org/licenses/by-nc-sa/3.0/. Attributions are to be made to HealthyDebate.ca, a project under the direction of Dr. Andreas Laupacis, at the Keenan Research Centre, Li Ka Shing Knowledge Institute of St. Michael’s Hospital.